Desleigh de Jonge

Restoring and Sustaining Home: The Impact of Home Modifications on the Meaning of Home for Older People

ABSTRACT The importance of a supportive home environment to successful aging has been well-established in the literature, with home modifications increasingly acknowledged as ways of removing barriers to function and increasing independence for older people. Home modification literature and practice primarily focus on the home environment as a physical space in which to perform tasks and on the impact of modification on competencies and function. Home, however, is much more than a physical environment. Within a transactive framework, people and places are seen as engaged in a dynamic, reciprocal relationship through which home becomes a place of significant personal meaning. Through a qualitative framework, this study examines the experience of older people living in the community who are recipients of a home modification service. It explores the impact modifying the physical environment has on their experience of home as a place of meaning and provides insight into how home modifications can strengthen the home as a place of personal and social meaning as well as improve safety and comfort for the older person at home.

Understanding the essence of home: Older people's experience of home in Australia

This qualitative inquiry explores the experiences of community-living older people in Australia living in their home environment. Semi-structured interviews were undertaken with 30 older people, aged 56-90, from three states in Australia. Purposive or maximum variation sampling was used to recruit people with diverse characteristics in terms of age, gender, living situation, dwelling type, tenure and location (urban/rural). Older people in this study stated that they were interested in the capacity of the house to support their many and varied occupations, particularly their ability to care for others. They also enjoyed the independence and autonomy that living in their own home afforded them. The location of the home in the community provided general convenience and offered opportunities for social connectedness. The home environment and the surrounding community also created an ambience and afforded people a particular lifestyle. The importance of the history of the home environment and the emotional connection older people have with the dwelling was another prevalent theme. Future research is recommended to investigate whether these views of the home are representative of other groups of older people and which aspects of the home they seek to retain when adapting their homes or relocating.

Using the ICF in economic analyses of Assistive Technology systems: methodological implications of a user standpoint.

Purpose. This paper identifies key methodological issues for economic analyses of costs and effectiveness of Assistive Technology (AT) systems based on the International Classification of Functioning, Disability and Health (ICF). Following the biopsychosocial model of the ICF, the paper explores the consequences for cost-effectiveness analyses of AT systems when a user centred approach is taken. In so doing, the paper questions the fiction of neutrality in economic analyses and discusses the distinction between weak and strong objectivity. Method. Costs are measured as all resources used when providing a particular level of environmental facilitators and reducing environmental barriers for an AT user, while effectiveness is measured in terms of the resulting increase in activities and participation of the AT user. The ICFs fourth qualifier for activities and participation, which denotes performance without assistance is used to identify the additional performance achieved due to the particular environmental factors in the current situation (first qualifier). A fifth qualifier for activities and participation is introduced to denote performance with optimal assistance, and the fourth qualifier is then again used to identify the increase in activities and participation due to the environmental factors in the situation with optimal assistance. Results. The effectiveness that an AT user achieves in his or her current situation can be compared with the effectiveness he or she could achieve when provided with what is considered an optimal AT system based on current technologies and user priorities. This comparison throws into sharp relief the role of AT systems as well as of universal design (UD) in reducing environmental barriers for AT users in a way that is cost-effective for society as a whole. Conclusion. Cost-effectiveness analysis based on the ICF can provide powerful economic evidence for how best to allocate existing funding for AT systems. We can identify three particular scenarios in which clear recommendations can be made. In addition, cost-effectiveness analysis provides a means to identify how society can comply with its obligation towards all its members in the most cost-effective way, using a combination of AT and UD.

Understanding the dimensions of home that impact on home modification decision making

BACKGROUND/AIM The home environment is a multidimensional and personally meaningful place, and the complexity of this environment often impacts on the home modification process and outcomes. Home modifications can appear as a straightforward solution to safety and occupational performance concerns; nevertheless, clients sometimes reject modifications or are unsatisfied with the completed works. To understand this phenomenon, this study aimed to determine what aspects of the home environment impact home modification decision making. METHOD In this qualitative descriptive study, 42 in-depth interviews using a semi-structured questionnaire were undertaken and analysed using a template analysis. The interviews explored the experience of the home modification process, including concerns and the decisions made about the modifications. FINDINGS Four dimensions of the home environment were commonly found to affect decision making namely, the personal, societal, physical and temporal dimensions of home as well as social and occupational dimensions. CONCLUSIONS An understanding of the dimensions of home that impact decision making provides occupational therapists with a greater appreciation of the experience of home and allows them to enhance the effectiveness and acceptance of home modifications.

Consumer-identified barriers and strategies for optimizing technology use in the workplace

Purpose. This article explores the experiences of 26 assistive technology (AT) users having a range of physical impairments as they optimized their use of technology in the workplace. Method. A qualitative research design was employed using in-depth, open-ended interviews and observations of AT users in the workplace. Results. Participants identified many factors that limited their use of technology such as discomfort and pain, limited knowledge of the technologys features, and the complexity of the technology. The amount of time required for training, limited work time available for mastery, cost of training and limitations of the training provided, resulted in an over-reliance on trial and error and informal support networks and a sense of isolation. AT users enhanced their use of technology by addressing the ergonomics of the workstation and customizing the technology to address individual needs and strategies. Other key strategies included tailored training and learning support as well as opportunities to practice using the technology and explore its features away from work demands. Conclusions. This research identified structures important for effective AT use in the workplace which need to be put in place to ensure that AT users are able to master and optimize their use of technology.

Understanding home modifications impact on clients and their family's experience of home: a qualitative study

BACKGROUND/AIM Home modifications aim to enhance safety and occupational performance in the home. However, given the complexity and unique meaning of the home, they can impact aspects other than function. This qualitative descriptive study aimed to explore the impact of home modifications on clients and their familys experience of home. METHODS Home modification clients and their family and carers participated in 42 in-depth interviews which were analysed using a template analysis. FINDINGS Home modifications impacted positively and negatively on five dimensions of the home environment, the personal, occupational, physical, temporal and social dimension. The outcomes of the modifications and the home modification process were influenced by three themes, workmanship, consultation or involvement in decision-making, and the societal dimension of the home environment. CONCLUSIONS The negative outcomes and poor consultation experiences suggest the need for occupational therapists to understand their clients personal experience of home and to comprehensively follow-up and evaluate these following home modifications.

The impact of becoming a father on other roles: An ethnographic study

Study Objectives: To look at the transition to becoming a father and the impact on other roles. Methods: A focused ethnography was undertaken for which a semi‐structured interview protocol was prepared based on the Occupational Performance History Interview (OPHI‐II) and issues highlighted in the literature. In‐depth interviews were conducted with a convenience sample of 4 Australian men and their partners who had all become first time parents during the previous year. Interviews were audio taped, transcribed, categorized, unitized, and examined for emerging themes. Triangulation included member checking and review by an independent researcher. Results: Although some of the themes that emerged were consistent with many of the findings in the literature there were some distinct differences: these mens occupational roles did change substantially after the birth of their first child and the importance of their working role also shifted. The themes that emerged included: becoming a father, role re‐negotiation, worker role, domestic roles, leisure role, loss of sleep, couple time, adopting the father role and facilitators and barriers to adopting their new occupational role ‘father’. Limitations: This is an exploratory study with a small sample of convenience. All of the participants were parents of girls and of Anglo European descent. No longitudinal data was collected.

Globalising accessibility: drawing on the experiences of developed countries to enable the participation of disabled people in Zambia

This paper explores the accessibility situation in a developing country such as Zambia. The global view of accessibility for disabled people is provided to examine the accessibility situation in developed and developing countries, highlighting the role of the environment in achieving rights for disabled people. Recognition of disability rights relating to accessible built environments is a necessary element to ensure their participation. Limited disability research, lack of disability policies and systems, evaluation of disability rights and support from developed countries have been cited as contributing to the non-recognition of disability rights and low participation by disabled people in Africa. An international perspective of disability, accessibility and participation and the experiences of developed countries are examined and their potential for advancing accessible built environments for participation in developing countries considered. However, accessibility concepts, having been developed in western countries, are presented with caution acknowledging the geographical, social–cultural and economic differences that exist.

Paediatricots: Utilisation of an Australian list serve to support occupational therapists working with children

BACKGROUND/AIM The development of list serves has enabled occupational therapists working in a range of practice settings and geographical locations to share information and provide each other with professional support. The aim of this study was to gain insight into the nature of communications occurring on the Paediatricots list serve, and determine whether topics and issues raised were congruent with current practice trends for therapists working with children. METHODS A content analysis was undertaken of all archived Paediatricots emails sent between 1 June 2003 and 31 May 2004, using the previous Yahoo paediatricots group. The group is now maintained by the NSW Department of Health. RESULTS A total of 2104 postings were made to Paediatricots during the 12-month period. These postings addressed a wide range of issues; however, the majority were of a clinical nature related to day-to-day practice. The focus of these communications was mainly on the performance components of childrens skills, with less emphasis on task demands, environmental factors and practice approaches. CONCLUSIONS The variety of issues raised, coupled with high membership levels and reciprocity rates, suggests that Paediatricots is providing a valuable professional resource for occupational therapists. Members appear to predominantly utilise the list serve to address day-to-day practice issues, particularly concerning performance components impacting on childrens occupations. The facility also served to support organisational and professional development needs.

Tracking down a solution: exploring the acceptability and value of wearable GPS devices for older persons, individuals with a disability and their support persons

Abstract Purpose: To explore the acceptability and value of three wearable GPS devices for older persons and individuals with a disability and safety concerns when accessing the community. Methods: This pilot study explored six wearers’ and their support persons’ experience of using three different wearable GPS devices (a pendant, watch, and mini GPS phone), each for a two-week period. Results: Participants identified safety as the main value of using a wearable GPS device. The acceptability and value of these devices was strongly influenced by device features, ease of use, cost, appearance, the reliability of the GPS coordinates, the wearer’s health condition and the users familiarity with technology. Overall, participants indicated that they preferred the pendant. Conclusions: Wearable GPS devices are potentially useful in providing individuals who have safety concerns with reassurance and access to assistance as required. To ensure successful utilization, future device design and device selection should consider the user’s familiarity with technology and their health condition. This study also revealed that not all wearable GPS devices provide continuous location tracking. It is therefore critical to ensure that the device’s location tracking functions address the wearer’s requirements and reason for using the device. Implications for Rehabilitation The acceptability and usability of wearable GPS devices is strongly influenced by the device features, ease of use, cost, appearance, the reliability of the device to provide accurate and timely GPS coordinates, as well as the health condition of the wearer and their familiarity with technology. Wearable GPS devices need to be simple to use and support and training is essential to ensure they are successfully utilized. Not all wearable GPS devices provide continuous location tracking and accuracy of location is impacted by line of sight to satellites. Therefore, care needs to be taken when choosing a suitable device, to ensure that the device’s location tracking features are based on the wearer’s requirements and value behind using the device.